18 October 2009

Because of my 21 patients tonight, no fewer than eleven had an influenza-like illness. We're not even bothering to test for it any more. The sensitivity of the test is about 70%, which is not much better than flipping a coin), and the CDC isn't recommending Tamiflu for healthy people, so why bother?

But I felt like a commando going right in while everybody else hovered about in their (useless) N95 masks. I was totally unafraid because I've already had influenza! You can't make me sick!

At least I hope not.

Funny side-note: We spent a whole bunch of time/money getting everybody in the ER fitted for N95 masks and developing the respiratory isolation protocols, and where do the patients with influenza get placed? In gurneys lining the hallways. Of course.

Hey Shadowfax, can you comment on the research on the N95 masks? I'm a weird nerdy very-interested-in public health issues and have been intrigued by the mask issues. I see some countries really going for the mask and others not, and have wondered if this is cultural or scientific. Sounds like the former from your comment. Can you point to the research for me?

Since you are pretty sure you've already had it, will you be getting the H1N1 shot? We are 99% sure we're passing swine flu around our house now, and just got word that the school will be bringing in people to vaccinate the kiddos. Seems silly to vaccinate for something they've probably already had, but....? How do you know? What are you doing?

We're not using the N95 masks unless we're expecting aerosolization, for example if a patient is being intubated or receiving a nebulizer. A simple coughing flu patient, you shouldn't need an n95 mask for protection. A regular surgical mask should do.

Are you putting regular surgical masks on patients? Anyone with any fever or respiratory symptoms is getting them in my ER.

My husband and I had it too, during July. We both lived (we have autoimmune disorders). I like to tell shocked people (You had swine flu! And you lived?!!?) that we are now all set for the post apocalypse.

I'm the only person who doesn't have it (at the moment) in my family...they're not testing individuals in Ontario right now unless they're hospitalized. We're also down to one pharmacy in our town (130,000 people) who has any Tamiflu left, and it looks like we just squeaked in under the line with the latest kid to get it as they figure that they'll be out this afternoon. My husband's at the hospital right now, and apparently the halls here are full of gurneys as well. The schools here are keeping kids out for 7-10 days if they're coughing regardless of whether they have a flu test or not.

So far all of the docs are still telling us to get vaccinated when it becomes available here.

Lordy how I wish we could tell the people who are flooding into the ER to just go home and take some tylenol or advil. Instead they sit around in the lobby for hours waiting to see the doctor who tells them the same thing. We give them antipyretics at triage so they feel better by the time the doctor or NP sees them but jeez. What the hell do they want from us? They come up to the desk and say "i think I've got swine flu" and we say "yes, it sure sounds like you do. The CDC is expecting up to 40% of the population to get it" Message:BFD

If they've followed the story enough to diagnose themselves why are they going to the ER? Haven't they heard the news that they just need to stay home and treat the symptoms?

Get over it people. Aren't the projections something like 20-40% of the world's population is going to get this thing. A billion people. Why do people act like its some sort of tragedy when they get it. Come talk to me when you're short of breath. Then we'll get a little concerned.

The pharmacies here have run out of tamiflu due to irresponsible prescribing by physicians. Now when people in the high risk groups need it, it won't be available for them. I really think the health departments should have taken control of all the supplies from the get go. Along with the vaccines. I'm working with pregnant nurses in an ER who haven't been able to get vaccinated yet, but fire departments have gotten 1000's of doses to vaccinate their families with.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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